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  • 1. Ahrne, Malin
    et al.
    Adan, Aisha
    Schytt, Erica
    Andersson, Ewa
    Small, Rhonda
    Flacking, Renée
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Byrskog, Ulrika
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Antenatal care for Somali born women in Sweden – perspectives from mothers, fathers and midwives2018Inngår i: European Journal of Public Health, Volume 28, Issue suppl_1, May 2018, 2018, Vol. 28Konferansepaper (Fagfellevurdert)
  • 2. Ahrne, Malin
    et al.
    Schytt, Erica
    Andersson, Ewa
    Small, Rhonda
    Adan, Aisha
    Essén, Birgitta
    Byrskog, Ulrika
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Antenatal care for Somali-born women in Sweden: Perspectives from mothers, fathers and midwives2019Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 74, s. 107-115Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To explore Somali-born parents' experiences of antenatal care in Sweden, antenatal care midwives´ experiences of caring for Somali-born parents, and their respective ideas about group antenatal care for Somali-born parents.

    DESIGN: Eight focus group discussions with 2-8 participants in each were conducted, three with Somali-born mothers, two with fathers and three with antenatal care midwives. The transcribed text was analysed using Attride-Stirling´s tool "Thematic networks".

    SETTING: Two towns in mid-Sweden and a suburb of the capital city of Sweden.

    PARTICIPANTS: Mothers (n = 16), fathers (n = 13) and midwives (n = 7) were recruited using purposeful sampling.

    FINDINGS: Somali-born mothers and fathers in Sweden were content with many aspects of antenatal care, but they also faced barriers. Challenges in the midwife-parent encounter related to tailoring of care to individual needs, dealing with stereotypes, addressing varied levels of health literacy, overcoming communication barriers and enabling partner involvement. Health system challenges related to accessibility of care, limited resources, and the need for clear, but flexible routines and supportive structures for parent education. Midwives confirmed these challenges and tried to address them but sometimes lacked the support, resources and tools to do so. Mothers, fathers and midwives thought that language-supported group antenatal care might help to improve communication, provide mutual support and enable better dialogue, but they were concerned that group care should still allow privacy when needed and not stereotype families according to their country of birth.

    KEY CONCLUSIONS: ANC interventions targeting inequalities between migrants and non-migrants may benefit from embracing a person-centred approach, as a means to counteract stereotypes, misunderstandings and prejudice. Group antenatal care has the potential to provide a platform for person-centred care and has other potential benefits in providing high-quality antenatal care for sub-groups that tend to receive less or poor quality care. Further research on how to address stereotypes and implicit bias in maternity care in the Swedish context is needed.

  • 3.
    Bogren, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Erlandsson, Kerstin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Byrskog, Ulrika
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    What prevents midwifery quality care in Bangladesh? A focus group enquiry with midwifery students2018Inngår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, nr 1, artikkel-id 639Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: With professional midwives being introduced in Bangladesh in 2013, the aim of this study was to describe midwifery students perceptions on midwives' realities in Bangladesh, based on their own experiences.

    METHOD: Data were collected through 14 focus group discussions that included a total of 67 third-year diploma midwifery students at public nursing institutes/colleges in different parts of Bangladesh. Data were analyzed deductively using an analytical framework identifying social, professional and economical barriers to the provision of quality care by midwifery personnel.

    RESULTS: The social barriers preventing midwifery quality care falls outside the parameters of Bangladeshi cultural norms that have been shaped by beliefs associated with religion, society, and gender norms. This puts midwives in a vulnerable position due to cultural prejudice. Professional barriers include heavy workloads with a shortage of staff who were not utilized to their full capacity within the health system. The reason for this was a lack of recognition in the medical hierarchy, leaving midwives with low levels of autonomy. Economical barriers were reflected by lack of supplies and hospital beds, midwives earning only low and/or irregular salaries, a lack of opportunities for recreation, and personal insecurity related to lack of housing and transportation.

    CONCLUSION: Without adequate support for midwives, to strengthen their self-confidence through education and through continuous professional and economic development, little can be achieved in terms of improving quality care of women during the period around early and late pregnancy including childbirth.The findings can be used for discussions aimed to mobilize a midwifery workforce across the continuum of care to deliver quality reproductive health care services. No matter how much adequate support is provided to midwives, to strengthen their self-confidence through education, continuous professional and economic development, addressing the social barriers is a prerequisite for provision of quality care.

  • 4.
    Byrskog, Ulrika
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Institutionen för kvinnors och barns hälsa, Uppsala Universitet. Centrum för klinisk forskning, Dalarna.
    'Moving On' and Transitional Bridges: Studies on migration, violence and wellbeing in encounters with Somali-born women and the maternity health care in Sweden2015Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    During the latest decade Somali-born women with experiences of long-lasting war followed by migration have increasingly encountered Swedish maternity care, where antenatal care midwives are assigned to ask questions about exposure to violence. The overall aim in this thesis was to gain deeper understanding of Somali-born women’s wellbeing and needs during the parallel transitions of migration to Sweden and childbearing, focusing on maternity healthcare encounters and violence. Data were obtained from medical records (paper I), qualitative interviews with Somali-born women (II, III) and Swedish antenatal care midwives (IV). Descriptive statistics and thematic analysis were used. Compared to pregnancies of Swedish-born women, Somali-born women’s pregnancies demonstrated later booking and less visits to antenatal care, more maternal morbidity but less psychiatric treatment, less medical pain relief during delivery and more emergency caesarean sections and small-for-gestational-age infants (I). Political violence with broken societal structures before migration contributed to up-rootedness, limited healthcare and absent state-based support to women subjected to violence, which reinforced reliance on social networks, own endurance and faith in Somalia (II). After migration, sources of wellbeing were a pragmatic “moving-on” approach including faith and motherhood, combined with social coherence. Lawful rights for women were appreciated but could concurrently risk creating power tensions in partner relationships. Generally, the Somali-born women associated the midwife more with providing medical care than with overall wellbeing or concerns about violence, but new societal resources were parallel incorporated with known resources (III). Midwives strived for woman-centered approaches beyond ethnicity and culture in care encounters, with language, social gaps and divergent views on violence as potential barriers in violence inquiry. Somali-born women’s strength and contentment were highlighted, and ongoing violence seldom encountered according to the midwives experiences (IV). Pragmatism including “moving on” combined with support from family and social networks, indicate capability to cope with violence and migration-related stress. However, this must be balanced against potential unspoken needs at individual level in care encounters.With trustful relationships, optimized interaction and networking with local Somali communities and across professions, the antenatal midwife can have a “bridging-function” in balancing between dual societies and contribute to healthy transitions in the new society.

  • 5.
    Byrskog, Ulrika
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Centrum för klinisk forskning, Dalarna, Institutionen för kvinnors och barns hälsa, Uppsala Universitet.
    Våld och reproduktiv hälsa i krigets skugga – somalisvenska perspektiv2014Konferansepaper (Annet vitenskapelig)
  • 6.
    Byrskog, Ulrika
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ahrne, Malin
    Small, Rhonda
    Andersson, Ewa
    Essen, Birgitta
    Adan, Aisha
    Ahmed, Fardosa Hassen
    Tesser, Karin
    Åhman-Berndtsson, Anna
    Schytt, Erica
    Rationale, development and feasibility of group antenatal care for immigrant women in Sweden: a study protocol for the Hooyo Project2019Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 7, artikkel-id e030314Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Somali-born women comprise a large group of immigrant women of childbearing age in Sweden, with increased risks for perinatal morbidity and mortality and poor experiences of care, despite the goal of providing equitable healthcare for the entire population. Rethinking how care is provided may help to improve outcomes.

    OVERALL AIM: To develop and test the acceptability, feasibility and immediate impacts of group antenatal care for Somali-born immigrant women, in an effort to improve experiences of antenatal care, knowledge about childbearing and the Swedish healthcare system, emotional well-being and ultimately, pregnancy outcomes. This protocol describes the rationale, planning and development of the study.

    METHODS AND ANALYSIS: An intervention development and feasibility study. Phase I includes needs assessment and development of contextual understanding using focus group discussions. In phase II, the intervention and evaluation tools, based on core values for quality care and person-centred care, are developed. Phase III includes the historically controlled evaluation in which relevant outcome measures are compared for women receiving individual care (2016-2018) and women receiving group antenatal care (2018-2019): care satisfaction (Migrant Friendly Maternity Care Questionnaire), emotional well-being (Edinburgh Postnatal Depression Scale), social support, childbirth fear, knowledge of Swedish maternity care, delivery outcomes. Phase IV includes the process evaluation, investigate process, feasibility and mechanisms of impact using field notes, observations, interviews and questionnaires. All phases are conducted in collaboration with a stakeholder reference group.

    ETHICS AND DISSEMINATION: The study is approved by the Regional Ethical Review Board, Stockholm, Sweden. Participants receive information about the study and their right to decline/withdraw without consequences. Consent is given prior to enrolment. Findings will be disseminated at antenatal care units, national/international conferences, through publications in peer-reviewed journals, seminars involving stakeholders, practitioners, community and via the project website. Participating women will receive a summary of results in their language.

  • 7.
    Byrskog, Ulrika
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ahrne, Malin
    Small, Rhonda
    Andersson, Ewa
    Essén, Birgitta
    Institutionen för kvinnors och barns hälsa, Uppsala Universitet .
    Adan, Aisha
    Hassen Ahmed, Fardosa
    Tesser, Karin
    Lidén, Yvonne
    Schytt, Erica
    Rationale, development and feasibility of group antenatal care for immigrant women in Sweden2019Konferansepaper (Fagfellevurdert)
  • 8.
    Byrskog, Ulrika
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Akther, Hasne Ara
    Khatoon, Zohra
    Bogren, Malin
    Erlandsson, Kerstin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Social, economic and professional barriers influencing midwives’ realities in Bangladesh: a qualitative study of midwifery educators preparing midwifery students for clinical reality2019Inngår i: Evidence Based Midwifery., ISSN 1479-4489, Vol. 17, nr 1, s. 19-26Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction

    Identifying existing barriers inhibiting the provision of quality care in Bangladesh can guide both the government, in fulfilling its commitment to establishing the midwifery profession, and midwifery educators, in preparing midwifery students for the reality of midwifery clinical work.

    Aim

    The aim of this study was to describe midwifery educators’ perceptions of midwives’ realities in Bangladesh, focusing on social, economic, and professional barriers preventing them from carrying out quality care.

    Methods

    Data were collected through focus group discussions with 17 midwifery educators and analysed using qualitative content analysis, guided by the analytical framework “What prevents quality midwifery care?”. Ethical clearance was obtained from Bangladesh’s Directorate General of Nursing and Midwifery.

    Results

    The results generated by the application of the framework included social barriers of gender structures in Bangladeshi society. This influenced entry into midwifery education, carrying out midwifery work safely, and the development of the profession. Economic barriers included challenges for Bangladesh as a low-income country with a large population, inadequate salaries, and staff shortages, adding extra strain to midwives’ working conditions. These social and economic barriers were further enhanced by professional barriers due to the midwifery profession not yet being fully established or acknowledged in the health system.

    Conclusions and implications

    The study presents novel country-specific perspectives but confirms the general underlying issues of gender inequality as a base for barriers preventing midwives from carrying out quality care, in line with the framework “What prevents quality midwifery care?”. Addressing these structures can facilitate more students to enter midwifery education, enable quality midwifery work free from discrimination, and provide sufficient working space and professional integrity. Leadership training is pivotal to increasing responsiveness to the needs of the new cadre of midwives. Midwifery educators should take the lead in sensitising clinical supervisors, mentors, and preceptors about midwives’ realities in Bangladesh.

  • 9.
    Byrskog, Ulrika
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Essén, Birgitta
    Olsson, Pia
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    ‘Moving on’: Violence, wellbeing and questions about violence in antenatal care encounters. A qualitative study with Somali-born refugees in Sweden2016Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 40, s. 10-17Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Somali-born women constitute one of the largest groups of childbearing refugee women in Sweden after more than two decades of political violence in Somalia. In Sweden, these women encounter antenatal care that includes routine questions about violence being asked. The aim of the study was to explore how Somali-born women understand and relate to violence and wellbeing during their migration transition and their views on being approached with questions about violence in Swedish antenatal care.

    Method

    Qualitative interviews (22) with Somali-born women (17) living in Sweden were conducted and analysed using thematic analysis.

    Findings

    A balancing actbetween keeping private life private and the new welfare system was identified, where the midwife's questions about violence were met with hesitance. The midwife was, however, considered a resource for access to support services in the new society. A focus on pragmatic strategies to move on in life, rather than dwelling on potential experiences of violence and related traumas, was prominent. Social networks, spiritual faith and motherhood were crucial for regaining coherence in the aftermath of war. Dialogue and mutual adjustments were identified as strategies used to overcome power tensions in intimate relationships undergoing transition.

    Conclusions

    If confidentiality and links between violence and health are explained and clarified during the care encounter, screening for violence can be more beneficial in relation to Somali-born women. The focus on “moving on” and rationality indicates strength and access to alternative resources, but needs to be balanced against risks for hidden needs in care encounters. A care environment with continuity of care and trustful relationships enhances possibilities for the midwife to balance these dual perspectives and identify potential needs. Collaborations between Somali communities, maternity care and social service providers can contribute with support to families in transition and bridge gaps to formal social and care services.

  • 10.
    Byrskog, Ulrika
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Essén, Birgitta
    Institutionen för kvinnors och barns hälsa, Uppsala Universitet .
    Olsson, Pia
    Institutionen för kvinnors och barns hälsa, Uppsala Universitet .
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Violence and reproductive health preceding flight from war: accounts from Somali born women in Sweden2014Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, artikkel-id 892Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden.

    Method: Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied.

    Results: Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war.

    Conclusions: Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and

  • 11.
    Byrskog, Ulrika
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Hussein, I. H.
    Yusuf, F. M.
    Egal, J. A.
    Erlandsson, Kerstin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    The situation for female survivors of non-partner sexual violence: A focused enquiry of Somali young women's views, knowledge and opinions2018Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 16, s. 39-44Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    The aim of the study is to elucidate young women’s perceptions of the situation for female survivors of non-partner sexual violence in Somaliland.

    Methods

    Young Somali women with diverse backgrounds (n = 25) shared views, knowledge and opinions about non partner sexual violence in focus group discussions held in urban settings. Data was analysed using content analysis.

    Results

    A main category “Bound by culture and community perceptions” with four subcategories comprises the informants’ perceptions of non-partner sexual violence among young women in Somaliland. Illuminated is the importance of protecting oneself and the family dignity, a fear of being rejected and mistrusted, how the juridical system exists in the shadow of tradition and potential keys to healthcare support.

    Conclusion

    The study raises awareness of the dilemmas which may be faced by young women subjected to non-partner sexual violence and healthcare providers in the intersection between state and traditional norms. Education is a key when it comes to a young woman considering the use of the services available in a society where traditional problem-solving is relied on parallel to state-based support. State-based functions, communities and families need to work together to provide comprehensive support to young female survivors of non-partner sexual violence in Somaliland.

  • 12.
    Byrskog, Ulrika
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Members of the Midwifery Faculty Master’s degree holders in Sexual and Reproductive Health and Rights, Bangladesh
    Bogren, Malin
    Erlandsson, Kerstin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Midwives realities in Bangladesh: A focus group enquiry with midwifery students and educators2019Konferansepaper (Fagfellevurdert)
  • 13.
    Byrskog, Ulrika
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Uppsala universitet; Centre for Clinical Research, Falun.
    Olsson, Pia
    Uppsala universitet.
    Essén, Birgitta
    Uppsala universitet.
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Being a bridge: Swedish antenatal care midwives’ encounters with Somali-born women and questions of violence; a qualitative study2015Inngår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, nr 1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence.

    Methods: Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis.

    Results: The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women’s’ strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman’s access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women.

    Conclusion: Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives’ ability to identify Somali born woman’s resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the midwife can be a bridge and contribute to increased awareness of rights and support for Somali-born women in a new society.

  • 14.
    Byrskog, Ulrika
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Centrum för klinisk forskning, Dalarna, Institutionen för kvinnors och barns hälsa, Uppsala Universitet. .
    Olsson, Pia
    Institutionen för kvinnors och barns hälsa, Uppsala Universitet .
    Essén, Birgitta
    Institutionen för kvinnors och barns hälsa, Uppsala Universitet .
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Perceptions and experiences of war, violence, migration and reproductive health among Somali refugee women in Sweden2013Inngår i: 19th Nordic Midwifery Congress - Nordic and Global Challenges: Book of abstracts, 2013, s. 75-Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Perceptions and experiences of war, violence and migration and related sexual and reproductive health among Somali refugee women in Sweden.

    Background and objectives: Sweden has during the latest six years experienced a twofold increase of Somali born refugees. Elevated levels of pregnancy related morbidity and perinatal complications are seen among Somali born refugee women.  Research has shown links between a mother´s prenatal stress and anxiety and the health of the child the first year. Furthermore, violence towards a mother-to-be has negative health effects and increases the neonatal mortality The specific aim in the current study was to explore perceptions and experiences of war, violence and migration among Somali refugee women in Sweden. This in order to find strategies in caring for birth giving Somali refugee women, with possible experiences of violence, which would benefit the woman and society at large.

    Material and methods: Qualitative individual audio-recorded interviews were conducted with Somali born refugee women in fertile ages. Interviews were held in three steps: 1) personal narratives by newly arrived Somali born women, 2) perceptions and views out of a depersonalized case and 3) reflections upon emerging themes by female key persons of Somali origin. Thematic analysis according to Clarke and Braun was applied.

    Preliminary results: The analysis resulted in two main themes: Lives controlled by the presence of violence and Sacrificing for the sake of a future. Access to education, livelihood opportunities and health facilities has been strictly limited by the long-lasting civil war. Escalated violations of sexual and reproductive health and rights were a common triggering factor for finalizing escape. Lives have been extensively marked by family separations. Patience created by war and a pragmatic orientation in life have made survival possible.

    Conclusions: To be presented at the congress

    Implications for practice: The results will provide increased evidence based knowledge useful to midwives when caring and supporting birth giving refugee women.

     

     

     

  • 15.
    Byrskog, Ulrika
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Centrum för klinisk forskning, Dalarna, Institutionen för kvinnors och barns hälsa, Uppsala Universitet. .
    Olsson, Pia
    Institutionen för kvinnors och barns hälsa, Uppsala Universitet .
    Essén, Birgitta
    Institutionen för kvinnors och barns hälsa, Uppsala Universitet .
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Violence, sexual and reproductive health and rights in Somalia: Qualitative interviews with Somali born women in Sweden2013Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Background: Political violence is a push factors for migration and social determinants of health among migrants. The Somali migration to Sweden has increased threefold during the latest six years, now comprising refugees with more than 20 years of war experiences. Adverse childbearing health and outcomes are reported among Somali born refugees in high income countries. Health is influenced by earlier life experiences and a link between adverse sexual and reproductive health, violence and mental distress is described in research. Therefore, the aim was to explore experiences and perceptions on war, violence and sexual and reproductive health before migration among Somali born women in Sweden.

     

    Method: Qualitative semi-structured individual interviews with Somali born refugee women living in Sweden were conducted, based on personal narratives and a hypothetical case. Thematic analysis was applied.

    Results: Escalating violence and power based restrictions permeated gradually all aspect of life and limited both access to and quality of reproductive health services in pre-migration Somalia. Formal societal support for women exposed to violence was absent. This reinforced shame and stigma connected to war related and community based sexual violence and the silence surrounding sexual and intimate partner violence. Women expressed survival strategies in the context of war based on social networks, pragmatism, strength and faith.

    Conclusions: Lack of formal structures on community levels has together with collective violence negatively impacted the whole spectra of women’s lives which have undermined the sexual and reproductive and health and rights. Several factors reinforce non-disclosure of violence exposure and can thus hamper health care seeking for violence related illness in the receiving country. Survival strategies shaped by war contain resources for resilience and enhancement of mental, sexual and reproductive health in receiving country.

    Keywords: Somalia, war, violence, refugee, sexual and reproductive health and rights, qualitative method, thematic analysis

     

  • 16.
    Erlandsson, Kerstin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Byrskog, Ulrika
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Osman, Fatumo
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Pedersen, Christina
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Hatakka, Mathias
    Högskolan Dalarna, Akademin Industri och samhälle, Informatik.
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Evaluating a model for the capacity building of midwifery eduators in Bangladesh through a blended, web-based master's programme2019Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, nr 1, artikkel-id 1652022Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: While setting international standards for midwifery education has attracted considerable global attention, the education and training of midwifery educators has been relatively neglected, particularly in low-resource settings where capacity building is crucial. Objective: The aim of this study was to describe the expectations of midwifery educators in Bangladesh who took part in a blended web-based master's programme in SRHR and the extent to which these were realized after 12 months of part-time study. Methods: Both quantitative and qualitative methods have been used to collect data. A structured baseline questionnaire was distributed to all participants at the start of the first course (n = 30) and a second endpoint questionnaire was distributed after they (n = 29) had completed the core courses one year later. At the start of the first course, five focus group discussions (FGD) were held with the midwifery educators. Descriptive statistics and content analysis were used for the analyses. Results: Midwifery educators who took part in the study identified expectations that can be grouped into three distinct areas. They hoped to become more familiar with technology, anticipated they would learn pedagogical and other skills that would enable them to better support their students' learning and thought they might acquire skills to empower their students as human beings. Participants reported they realized these ambitions, attributing the master's programme with helping them take responsibility for their own teaching and learning, showing them how to enhance their students' learning and how to foster reflective and critical thinking among them. Conclusions: Midwifery educators have taken part in a creative learning environment which has developed their engagement in teaching and learning. They have done this using a blended learning model which combines online learning with face-to-face contact. This model can be scaled up in low resource and remote settings.

  • 17.
    Erlandsson, Kerstin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Osman, Fatumo
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Hatakka, Mathias
    Högskolan Dalarna, Akademin Industri och samhälle, Informatik.
    Egal, Jama Ali
    Byrskog, Ulrika
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Pedersen, Christina
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Evaluation of an online master’s programme in Somaliland. A phenomenographic study on the experience of professional and personal development among midwifery faculty2017Inngår i: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 25, s. 96-103Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To record the variation of perceptions of midwifery faculty in terms of the possibilities and challenges related to the completion of their first online master's level programme in Sexual and Reproductive Health and Rights in Somaliland. The informants included in this phenomenongraphical focus group study were those well-educated professional women and men who completed the master's program. The informant perceived that this first online master's level programme provided tools for independent use of the Internet and independent searching for evidence-based information, enhanced professional development, was challenge-driven and evoked curiosity, challenged professional development, enhanced personal development and challenged context-bound career paths. Online education makes it possible for well-educated professional women to continue higher education. It furthermore increased the informants' confidence in their use of Internet, software and databases and in the use of evidence in both their teaching and their clinical practice. Programmes such as the one described in this paper could counter the difficulties ensuring best practice by having a critical mass of midwives who will be able to continually gather contemporary midwifery evidence and use it to ensure best practice. An increase of online education is suggested in South-central Somalia and in similar settings globally.

  • 18.
    Faysal Badal, Naciima
    et al.
    Department of Nursing, Hargeisa University.
    Alo Yusuf, Ubax
    Department of Nursing, Hargeisa University.
    Egal, Jama
    Department of Nursing, Hargeisa University.
    Pedersen, Christina
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Erlandsson, Kerstin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Osman, Fatumo
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Byrskog, Ulrika
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    With knowledge and support women can attend antenatal care: the views of women in IDP camps in Somaliland2018Inngår i: African Journal of Midwifery and Womens' Health, ISSN 1759-7374, Vol. 12, nr 3Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In Somaliland, women’s perceptions of barriers to accessing antenatal care is sparsely described, particularly with regard to marginalized women. The aim was to investigate perceptions of barriers to accessing antenatal care from the perspective of pregnant women living in Internal Displaced Persons camps. Individual semi-structured interviews with fifteen women were conducted and analysed using content analysis. The overriding theme was “With knowledge and support, women can attend antenatal care”.  The findings highlighted that to obtain antenatal care, it is crucial for women to have knowledge and trust regarding antenatal services, a supporting environment, and ways to overcome practical barriers, such as patient fees and long waiting hours. If women and families received relevant information about the structure and benefits of ANC, they would probably prioritize ANC, given that the care is tailored to each woman’s needs. For this, community awareness and trust between women, families and ANC providers are central.

  • 19.
    Klingberg-Allvin, Marie
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Hatakka, Mathias
    Högskolan Dalarna, Akademin Industri och samhälle, Informatik.
    Erlandsson, Kerstin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Osman, Fatumo
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Byrskog, Ulrika
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Egal, Jama
    "Change-makers in midwifery care": Exploring the differences between expectations and outcomes - a qualitative study of a midwifery net-based education programme in the Somali region2019Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 69, s. 135-142Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study is to explore midwifery educators’ expected outcomes in the net-based master's programme, the programmes’ realised outcomes and the reported difference regarding the increased choices for the graduates and the effect on their agency.

    Design

    In this case study, we focused on a net-based master's programme in sexual and reproductive health in Somalia. Somalia suffers from a shortage of skilled birth attendants and there is a need for building up the capacity of midwifery educators.

    Setting and participants

    Data was collected in focus group discussions at the start of the programme and eight months after the students graduated. The data were analysed through the lens of the choice framework, which is based on the capability approach.

    Findings

    Findings show that many of the graduates’ expectations were met, while some were more difficult to fulfil. While the midwives’ choices and resource portfolios had improved because of their role as educators, the social structure prevented them from acting on their agency, specifically in regards to making changes at the social level. Several of the positive developments can be attributed to the pedagogy and structure of the programme.

    Conclusion

    The flexibility of net-based education gave the midwifery educators a new educational opportunity that they previously did not have. Students gained increased power and influence on some levels. However, they still lack power in government organisations where, in addition to their role as educators, they could use their skills and knowledge to change policies at the social level.

  • 20. Mohamoud Osman, Hodan
    et al.
    Ali Egal, Jama
    Kiruja, Jonah
    Osman, Fatumo
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Byrskog, Ulrika
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Erlandsson, Kerstin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Women’s experiences of stillbirth in Somaliland: A phenomenological description2017Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 11, nr 1, s. 107-111Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Low- and middle-income countries in Africa have the highest rates of stillbirths in the world today: as such, the stories of the grief of these women who have had a stillbirth in these settings need to be told and the silence on stillbirth needs to be broken. In an attempt to fill this gap, the aim of this study was to describe the experiences of Muslim Somali mothers who have lost their babies at birth.

    Method: Qualitative interviews with ten Somali women one to six months after they experienced a stillbirth. Data were analyzed using Giorgi's method of phenomenological description.

    Results: In the analysis, four descriptive structures emerged: “a feeling of alienation”; “altered stability in life”; “immediate pain when the sight of the dead baby turns into a precious memory”; and “a wave of despair eases”. Together, these supported the essence: “Balancing feelings of anxiety, fear and worries for one's own health and life by accepting Allah's will and putting one's trust in him”.

    Conclusions: This study makes an important contribution to our knowledge about how stillbirth is experienced by women in Somaliland. This information can be useful when health care providers communicate the experiences of stillbirth to women of Muslim faith who have experienced an intrauterine fatal death (IUFD) resulting in a stillbirth. 

  • 21.
    Råssjö, Eva-Britta
    et al.
    Falun Cent Hosp, Dept Obstet & Gynaecol, Falun, Sweden; Clin Res Ctr, Dalarna, Sweden.
    Byrskog, Ulrika
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Falun Cent Hosp, Dept Obstet & Gynaecol, Falun, Sweden; Dalarna Univ, Sch Hlth & Social Sci, Falun, Sweden.
    Samir, Raghad
    Falun Cent Hosp, Dept Obstet & Gynaecol, Falun, Sweden ; Clin Res Ctr, Dalarna, Sweden.
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Inst, Dept Womens & Childrens Hlth, S-10401 Stockholm, Sweden.
    Somali women’s use of maternity health services and the outcome of their pregnancies: a descriptive study comparing Somali migrants with inborn Swedish Women2013Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, nr 3, s. 99-106Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To describe how Somali immigrant women in a Swedish county access and use the antenatal care and health services, their reported and observed health problems and the outcome of their pregnancies.

    Study design: Retrospective, descriptive study, comparing data obtained from the records of antenatal and obstetric care for Somali born women with the same data for parity matched women born in Sweden giving birth between 2001 and 2009.

    Main outcome measures: Utilisation of antenatal health care (timing and number of visits), pregnancy complications (severe hyperemesis, anaemia, preeclampsia, urinary tract infections), mode of birth (normal vaginal, operative vaginal, caesarean), and infant outcomes (preterm birth, birth weight, and perinatal mortality)

    Results: Compared to the 523 Swedish-born women the 262 Somali women booked later and made less visits for antenatal care. They were more likely to have anaemia, severe hyperemesis and recurrent urinary tract infection. Emergency caesarean section (OR 9.90, CI 1.16-3.10), especially before start of labour (OR 4.96, CI 1.73-14.22), high perinatal mortality  with seven versus one perinatal deaths and small for date infants (OR 2.95, CI 1.49-5.82) was also more prevalent.

    Conclusion: Pregnant Somali immigrant women constitutes a vulnerable group that needs targeted attention. There is an increased risk for intrauterine foetal death, small for date and low birth weight infants as well as serious maternal morbidity.

     

     

     

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